经曰∶关元隐隐痛者小肠疽，其上肉微起者小肠痈。（关元穴，又名小肠募，在脐下三寸。）
《千金》曰∶肠痈之为病，小腹肿，强按则痛，便数似淋。
《厥论》曰∶少阳厥逆，机关不利。机关不利者，腰不可以行，项不可以顾，发肠痈不可治，惊则死。
王肯堂曰∶《千金》谓妄治必杀人。肠痈为病，小腹重而强按之则痛，便数似淋，
时时汗出，复恶寒，身皮甲错，腹皮急如肿状，其脉数者，小肠有脓也。（《准绳》）
陈无择曰∶肠痈为病，身甲错，腹皮急，按之濡，如肿状，腹无聚积，身无热，
脉数，此为肠内有脓，久积阴冷所成也。故《金匮》有用附子温之。其脉迟紧者，脓未
成，可下之，当有血；洪数者，脓已成，不可下，此以内结热所成也，故《金匮》有用大黄利之。
张仲景曰∶肠痈，小腹痞坚，盖小腹痛而痞，小便数而似淋者。肠痈，即肺痈肝痈之属。
巢氏曰∶洪数者已有脓，脉若迟紧者未有脓。甚则腹胀大，转侧有水声，或绕
脐生疮，或脓自脐出，或大便出脓血。
张景岳曰∶经言肠痈为病不可惊，惊
则肠断而死。故患是者其坐卧转侧，极宜徐缓，时时少饮薄粥及八珍汤，固其元气，
静养调理，庶可保其有生。（《全书》）
薛立斋曰∶此证因七情饮食所致。
又曰∶若脐间出脓者不治。
孙真人曰∶肠痈小腹重，强按之则痛，小便如淋，时时汗出，复恶寒，身皮甲错，
腹皮急，加肿甚者，腹胀大转侧有水声，或绕脐生疮，脓从脐出，或从大便下，乃七
情饮食所致。脉迟紧者未有脓也，大黄汤下之；洪数者，已有脓也，薏苡汤排之；小
腹疼痛，小便不利，脓壅滞也，牡丹皮散主之。
陈实功曰∶肠痈初起，发热恶寒，脉芤而数，皮毛错纵，腹急渐肿，按之急痛，
大便坠重，小便涩滞若淋，甚者脐突腹胀，转侧水声，皆由湿热瘀血流入小肠而成痈也。（《正宗》）
又曰∶男子暴急奔走，以致肠胃传送不能舒利，败血浊气壅遏而成。妇人产后
体虚，多卧未经起坐而成。妇人坐草艰难，用力太过而成，妇人分娩后，失逐败瘀，以
致败血停积肠胃，结滞而成。饥饱劳伤，担负重物，致伤肠胃而成。醉饱房劳，过伤
精力，或生冷并进，以致气血乖违，湿动痰生，多致肠胃痞塞，运化不通，气血凝滞，皆能致之。
又曰∶初起未成，小腹殷殷作痛，俨似奔豚，小便淋沥者，当以大黄汤下之，瘀
血去尽自安；体虚脉细，不敢下者，活血散瘀汤和利之。
又曰∶腹濡而痛，小腹急胀，时时下脓者，毒未解也，用牡丹皮汤治之。
又曰∶已成，腹中疼痛，胀满不食，便淋刺痛者，薏苡仁汤主之。
又曰∶如脓从脐出，腹胀不除，饮食减少，面白神疲，此乃气血两亏，宜用八
珍汤加牡丹皮、肉桂、黄 、北五味敛而补之。
又曰∶如积袭日久，因循不识此证，误
作胀病治之，以致毒攻五内，肠胃受伤，或致阴器攻烂，腐靥黑斑，色败无脓，时流
污水，腹连阴痛，烦躁不止，身热口干，衾帏多臭，卧房难进者，俱为不治。
冯鲁瞻曰∶小肠痈作痛者，其身甲错，腹皮紧，按之濡，如肿状，腹常痛或绕脐生疮，急宜下之。（《锦囊》）
又曰∶一室女时患腹痛，食少面黄肌瘦，幼科治以退热消积，女科治以通经行
血，大方以虚而议补，俱不效。后有识者曰∶脉大而尺独数，肌肤甲错，（甲错，不滑泽
也。）此小肠有痈，脓已成而将溃矣。亟与葵根一两，金银花三钱，甘草节一钱，皂角
刺、陈皮各二钱，再剂而脓血大溃，更以太乙膏同参 治之，一月始安。
又曰∶肠痈是膏粱积热所致。其候身皮甲错，腹皮急，按之濡，如肿状，绕脐
生疮，小腹按之则痛，溲数似淋，腹胀恶寒，身热自汗。如脉沉紧而未有脓，须急
解毒；如脉洪数已有脓，须急下脓；若小腹痛而小便闭者，是脓壅滞也。然肠痈为
病，切不可惊，惊则肠断，故坐卧转侧，切宜徐缓，并饮薄粥及八珍汤以固元气，静养调理，庶可保也。
李东垣曰∶肠痈绕脐生疮，脓从疮出者，有出脐中者。惟大便下脓血者，自愈也。（《十书》）
申斗垣曰∶肠内生痈，当验证明白，不可妄治，妄则杀人。其病小腹重，按之痛，
小便如淋，时时汗出恶寒，身皮错，腹皮急，绕脐生疮，或脐出脓，或大便脓血。如
左肿甚者，左寸洪数，是小肠痈；右肿甚者，右寸洪数，是大肠痈。（《启玄》）
朱丹溪曰∶肌肤甲错，腹皮紧小，腹痛小便以淋，时时汗出或引大腹痛，按之
濡，若肿状，腹无积聚，身不发热，脉不弦数，此肠中有痈，久积阴冷所致。宜用
浊热之剂以温发之，故《金匮》有用附子温之者。
何氏曰∶凡肠痈男左女右，脚曲不能
伸者是。若误作阴疝与伤寒治之，为祸不小。（《济生》）
胡公弼曰∶按脐下一寸三分，即肠之屈曲间，大肠左盘，小肠右曲。其生痈也，
由冷毒积久，肠浓而不能发越于外，故生于内，外视之无形，重按之痛甚，毒生于
左侧左足不能伸，毒生于右侧右足不能伸，生毒之外肌肤微有皱纹，细观亦觉微肿。此
证当服牛胶酒吞太乙膏丸追脓解毒，治一不善，则难救矣。（《青囊》）
窦汉卿曰∶膀胱有热，蓄毒不流，结成此候，以致脐中坚硬结核，小便疼痛，日
夜下利无度是也。外宜用连须葱十根捣烂罨脐上。
又曰∶妇人肠痈与男子不同，乃心经毒流小肠经，发在脐中，坚硬如石，此是恶候也，宜内托。
又曰∶肠痈，若大便或脐间出脓者，不治。
《内经》曰∶肠痈为病不可惊，惊则肠断而死，故患是者，其坐卧转侧，务宜徐
缓，时少饮薄粥及服八珍汤，固其元气，静养调理，庶可保全其生。（《全书》）
《千金方》灸法∶曲两肘，正肘头锐骨，灸百壮，下脓血而安。
《脉经》∶问曰∶羽林妇病何以知肠有痈？师曰∶脉滑而数，滑则为实，数则为
热；滑则为荣，数则为卫；卫数下降，荣滑上升，荣卫相干为败浊，小腹痞坚，小
便或涩，或自汗出，或复恶寒，脓为已成，设脉迟紧，则为瘀血，血下即安。
陈远公曰∶有腹疼口渴，左足不伸，伸则疼甚，手按之犹不可忍，人以为肠中生
痈也。然肠痈有大小肠之分，屈右足者，大肠生痈也。屈左足者，小肠生痈也。今屈
左足是小肠生痈矣。但大肠痈易治，小肠痈难医，以大肠可泻，小肠难泻也。然得
法又何不可泻哉。盖大肠泻火从糟粕而出，小肠泻火从溲溺而泄也。泄毒至神汤∶银
花三两，茯苓、薏苡各一两，甘草、车前
子、刘寄奴、泽泻各三钱，肉桂一分。水煎服，一剂水如注，二剂疼大减，三剂全
愈。此方俱利水之味，只金银花消毒，何神奇至此？盖小肠之毒，必须内消，内消
之药，舍金银花无他味可代，以他味消毒，皆损正气，而小肠决不可伤，故以金银花
为君也。但此物不能入小肠，今同茯苡车泽之类引入小肠，又少加肉桂引入膀胱，从
溲溺而化，又恐火毒太旺，各药不能迅逐，加入寄奴之速祛，甘草之缓调，既无留滞
之患，又无峻烈之害，火毒自从膀胱小肠出也。（《冰鉴》）
又曰∶人有腹痛呼号，却在左腹，按之疼不可忍，人以为食积在大肠也，谁知
小肠生痈乎！凡肠痈必屈足，而今足不屈，似非肠痈。然痈生肠内者必屈其足，在大
肠内者屈右足而不伸，在小肠内者屈左足而不伸，若痈生肠外，皆不屈足。疼在左
则小肠生痈，疼在右则大肠生痈也。至食积燥屎之痛，时疼时止，生痈之痛，乃定
而不移，痛而不止也。故疼在左，乃小肠之外生痈也，痈生二肠之内，尚可破溃，生
于肠外不可使溃，以肠外无可出之路，皆死证也。而小肠尤甚，必早治之。内化丹∶
金银花四两，车前子五钱，白茯苓、薏仁各一两，生甘草三钱。水煎服，三剂疼止，
四剂全愈。（此即前方之变也，前方利水之中，行其败毒之法。此方入当归二两，利水之中补血败毒之法也。盖
痈破利水而毒随水出，易于祛除。痈未破，不补血以利水，则水泄而血虚，难于消化，同中之异，不可不知，总
宜早治，否则痈虽愈而瘀血流于肠外，必有终身腹痛之病也，慎之。）
又曰∶有腹疼骤甚，小便流血，左足不能伸，人以为小肠痈也，谁知小肠火盛
乎！夫小肠生痈，必屈左足，今足不伸，明是生痈，而曰火盛者何故？不知生痈必有
其征，未有一旦骤生而即流血者也。痈日久而生脓，脓欲尽而血出，岂有不溃而先
出血者，然今足不伸何也？盖小肠与大肠不同，小肠细而大肠宽，宽者可以容邪，细
者难以容邪，必然之理也。小肠受火煎熬，
肠中逼迫，肠不能舒，而左足暂屈，不若生痈者长屈而不伸也。勿以足不伸即信是
痈，妄行解毒。然何以辨之？初病之时，辨其小便中有血无血耳。初痛而足屈，小便
无血，乃是生痈；初痛而足屈，小便有血，乃是火痛，不可差也。治法泻其火邪，不
必化毒而痛止足伸矣。小柴胡汤加味以治之∶柴胡、半夏、甘草各一钱，人参二钱，
茯苓五钱，黄芩三钱。水煎服。一剂足伸，二剂血痛俱止。（按小柴胡汤非治小肠之方也，何从
应效如此之捷？夫小肠火盛者，起于肝胆之郁也，木郁则火生，不敢犯心而犯小肠耳。夫火性炎上，今反下炽，
拂火之性矣，所以小肠受而作痛也。小便流血者，乃小肠之血为火所逼，血恐为火灼干，越出小肠之外，直走
膀胱，反使水道不行而流血也。小柴胡舒肝之气，则火气上炎，其性既顺，
又得茯苓清渗水气，水流而血自归经，此方之所以奇耳。）
《黄帝内经》说：关元穴处隐隐作痛的是小肠疽，如果该部位肌肉微微隆起的是小肠痈。（关元穴，又称小肠募穴，位于脐下三寸。）
《千金方》说：肠痈这种病，小腹部肿胀，用力按压则疼痛，小便频数类似淋证。
《厥论》说：少阳经气机逆乱，关节活动不利。关节活动不利的人，腰部不能行走，颈部不能回顾，若发生肠痈则不可治愈，受惊则会死亡。
王肯堂说：《千金方》认为误治必定致人死亡。肠痈这种病，小腹沉重且用力按压则疼痛，小便频数类似淋证，时常出汗，又恶寒，皮肤粗糙如鳞甲状，腹皮紧张如同肿胀之状，脉象数的，说明小肠内有脓。（出自《医学准绳六要》）
陈无择说：肠痈这种病，身体皮肤粗糙如鳞甲状，腹皮紧张，按压柔软，像是有肿物，腹部没有积聚块，身体不发热，脉象数，这是肠内有脓，是由久积阴冷所形成的。所以《金匮要略》有用附子来温阳的方剂。如果脉象迟而紧，说明脓未形成，可以用攻下法，应当排出瘀血；如果脉象洪大且数，说明脓已形成，不可用攻下法，这是由内部结聚热邪所形成，所以《金匮要略》有用大黄来通利的方剂。
张仲景说：肠痈，小腹部痞塞坚硬，大概是小腹痛且痞满，小便频数且类似淋证。肠痈，属于肺痈、肝痈之类。
巢元方说：脉象洪数者已有脓，脉象若迟紧者未有脓。严重时腹胀大，翻身转动时有水声，或者绕脐生疮，或者脓液从脐部流出，或者大便排出脓血。
张景岳说：经文说肠痈发病不可受惊，受惊则肠断而死。所以患此病的人，其坐卧转身动作，极宜缓慢，时常少量饮用薄粥及八珍汤，以巩固元气，静养调理，才可以保全生命。（出自《景岳全书》）
薛立斋说：此证因七情内伤和饮食不当所致。
又说：如果脐间流出脓液的，属于不治之症。
孙思邈说：肠痈小腹部沉重，用力按压则疼痛，小便像淋证一样，时常出汗，又恶寒，身体皮肤粗糙如鳞甲状，腹皮紧张，加之上肿严重的，腹胀大翻身转动时有水声，或者绕脐生疮，脓液从脐部流出，或者从大便排出，乃是由七情内伤和饮食不当所致。脉象迟紧的，说明未有脓，用大黄汤攻下；脉象洪数的，说明已有脓，用薏苡仁汤排脓；小腹部疼痛，小便不利，是脓液壅滞，主用牡丹皮散。
陈实功说：肠痈初起时，发热恶寒，脉象芤而数，皮毛错纵粗糙，腹皮紧急逐渐肿胀，按压时急痛，大便有坠重感，小便涩滞类似淋证，严重的脐突腹胀，翻身转动有水声，皆是由湿热瘀血流入小肠而成痈。（出自《外科正宗》）
又说：男子暴急奔走，导致肠胃传导功能不能舒展通畅，败血浊气壅遏而形成。妇人产后体虚，多卧床未经起身活动而形成。妇人在分娩时艰难，用力太过而形成；妇人分娩后，未能驱逐败血瘀滞，导致败血停积在肠胃，结滞而成。饥饱劳伤，担负重物，导致损伤肠胃而形成。醉酒后饱食或房事劳累，过度损伤精力，或生冷食物并进，导致气血乖违，湿动痰生，多导致肠胃痞塞，运化不通，气血凝滞，都能导致此病。
又说：初起未成脓时，小腹隐隐作痛，很像奔豚病，小便淋沥不尽的，应当用大黄汤攻下，瘀血去尽自然安宁；体质虚弱脉细，不敢用攻下法的，用活血散瘀汤调和利导。
又说：腹部柔软而痛，小腹部急胀，时常排出脓液的，说明毒邪未解，用牡丹皮汤治疗。
又说：脓已成时，腹中疼痛，胀满不能进食，小便淋沥刺痛，主用薏苡仁汤。
又说：如果脓液从脐部流出，腹胀不除，饮食减少，面色苍白精神疲惫，这是气血两亏，宜用八珍汤加牡丹皮、肉桂、北五味子收敛并补益。
又说：如果病情迁延日久，因循守旧不识此证，误当作胀病治疗，以致毒邪攻犯五脏，肠胃受伤，或者导致阴器溃烂，出现腐靥黑斑，色泽败坏无脓，时常流污水，腹部牵连阴部疼痛，烦躁不止，身热口干，被褥蚊帐多有臭味，卧室难以进入的，都属于不治之症。
冯鲁瞻说：小肠痈发作疼痛的，身体皮肤粗糙如鳞甲状，腹皮紧绷，按压柔软，像是有肿物，腹部常痛或绕脐生疮，急需攻下。（出自《外科锦囊》）
又说：有一位室女时常患腹痛，食少面黄肌瘦，儿科医生用退热消积法治疗，妇科医生用通经行血法治疗，大方医生根据虚证议定补法，都无效。后来有识之士说：脉象大而尺脉独数，肌肤粗糙如鳞甲状（甲错，指皮肤不滑泽），这是小肠有痈，脓已成且即将溃破。急忙给予葵根一两，金银花三钱，甘草节一钱，皂角刺、陈皮各二钱，再服两剂后脓血大量溃出，随后以太乙膏同人参治疗，一个月才安定。
又说：肠痈是膏粱厚味积热所致。其症状为身体皮肤粗糙如鳞甲状，腹皮紧张，按压柔软，像是有肿物，绕脐生疮，小腹按压则痛，小便频数类似淋证，腹胀恶寒，身热自汗。如果脉象沉紧且未有脓，须紧急解毒；如果脉象洪数已有脓，须紧急排脓；如果小腹痛且小便闭塞，是脓液壅滞。然而肠痈发病，切不可受惊，受惊则肠断，所以坐卧转身切宜缓慢，并饮用薄粥及八珍汤以巩固元气，静养调理，才可以保全。
李东垣说：肠痈绕脐生疮，脓从疮口流出，有的从脐中流出。只有大便排出脓血的，可以自愈。（出自《脾胃论》等十书）
申斗垣说：肠内生痈，应当验证证明明白，不可妄治，妄治则杀人。其病小腹部沉重，按压则痛，小便像淋证，时常出汗恶寒，身体皮肤粗糙，腹皮紧张，绕脐生疮，或者脐部出脓，或者大便脓血。如果左侧肿胀严重，左寸脉洪数，是小肠痈；右侧肿胀严重，右寸脉洪数，是大肠痈。（出自《眼科启玄》）
朱丹溪说：肌肤粗糙如鳞甲状，腹皮紧小，腹痛小便淋沥，时常出汗或牵引大腹痛，按压柔软，像是有肿物，腹部没有积聚块，身体不发热，脉象不弦数，这是肠中有痈，由久积阴冷所致。宜用温热之剂以温散发之，所以《金匮要略》有用附子温阳的方剂。
何氏说：凡是肠痈，男性左侧、女性右侧，脚弯曲不能伸直的就是。如果误作阴疝与伤寒治疗，祸害不小。（出自《济生方》）
胡公弼说：按脐下一寸三分，即是肠的屈曲间，大肠在左侧盘绕，小肠在右侧屈曲。其生痈，是由于冷毒积久，肠脓而不能发散于外，故生于内，外视之无形，重按之痛甚，毒生于左侧则左足不能伸，毒生于右侧则右足不能伸，生毒之外的肌肤微有皱纹，细看也觉得微肿。此证应当服用牛胶酒吞服太乙膏丸追脓解毒，治疗稍有不善，则难救了。（出自《青囊秘传》）
窦汉卿说：膀胱有热，蓄毒不流，结成此候，以致脐中坚硬结核，小便疼痛，日夜下利无度就是这种情况。外用连须葱十根捣烂敷在脐上。
又说：妇人肠痈与男子不同，乃是心经毒邪流注小肠经，发在脐中，坚硬如石，这是恶候，宜用内托法。
又说：肠痈，如果大便或脐间流出脓液的，属于不治之症。
《黄帝内经》说：肠痈发病不可受惊，受惊则肠断而死，所以患此病的人，其坐卧转身，务必缓慢，时常少量饮用薄粥及服用八珍汤，巩固元气，静养调理，才可以保全生命。（出自《景岳全书》）
《千金方》灸法：弯曲两肘，正对肘头锐骨，灸百壮，排出脓血后安宁。
《脉经》问曰：如何知道羽林妇患有肠痈？老师说：脉象滑而数，滑则为实邪，数则为热邪；滑则代表营气，数则代表卫气；卫气数降，营气滑升，营卫相干成为败浊，小腹部痞塞坚硬，小便或涩滞，或自汗出，或复恶寒，脓已生成，如果脉象迟紧，则是瘀血，血下行即安宁。
陈远公说：有人腹疼口渴，左足不能伸直，伸直则疼痛加剧，手按之仍不可忍受，人们以为肠中生痈。然而肠痈有大肠和小肠之分，屈右足的，是大肠生痈。屈左足的，是小肠生痈。现在屈左足，是小肠生痈了。但大肠痈易治，小肠痈难医，因为大肠可泻，小肠难泻。然而得法又何尝不可泻呢？盖大肠泻火从糟粕而出，小肠泻火从小便而泄也。泄毒至神汤：银花三两，茯苓、薏苡仁各一两，甘草、车前子、刘寄奴、泽泻各三钱，肉桂一分。水煎服，一剂后水样排泄如注，二剂后疼痛大减，三剂后痊愈。此方全是利水之药，只金银花消毒，为何如此神奇？盖小肠之毒，必须内消，内消之药，舍金银花无他味可代，因为其他药物消毒，皆损正气，而小肠决不可伤，故以金银花为君药。但此物不能入小肠，今同茯苓、薏苡仁、车前子、泽泻之类引入小肠，又少加肉桂引入膀胱，从小便而化，又恐火毒太旺，各药不能迅速驱逐，加入刘寄奴之速祛，甘草之缓调，既无留滞之患，又无峻烈之害，火毒自然从膀胱小肠排出。（出自《辨证录》）
又说：有人腹痛呼号，却在左腹，按之疼不可忍，人们以为食积在大肠，谁知是小肠生痈！凡肠痈必屈足，而现在足不屈，似乎不是肠痈。然而痈生在肠内者必屈其足，在大肠内者屈右足而不伸，在小肠内者屈左足而不伸，若痈生在肠外，皆不屈足。疼在左侧则小肠生痈，疼在右侧则大肠生痈也。至于食积燥屎之痛，时疼时止，生痈之痛，乃固定不移，痛而不止也。故疼在左侧，乃小肠之外生痈也，痈生在二肠之内，尚可破溃，生于肠外不可使溃，因为肠外无可出路，都是死证。而小肠尤甚，必须早治。内化丹：金银花四两，车前子五钱，白茯苓、薏仁各一两，生甘草三钱。水煎服，三剂疼痛停止，四剂痊愈。（此即前方之变方，前方在利水中行败毒之法。此方加入当归二两，在利水中补血败毒。盖痈破利水而毒随水出，易于祛除。痈未破，不补血以利水，则水泄而血虚，难于消化，同中之异，不可不知，总宜早治，否则痈虽愈而瘀血流于肠外，必有终身腹痛之病也，慎之。）
又说：有人腹疼骤甚，小便流血，左足不能伸直，人们以为是小肠痈，谁知是小肠火盛呢！夫小肠生痈，必屈左足，现在足不伸，明是生痈，而说火盛是什么原因？不知道生痈必有其征象，没有一旦骤生而即流血者。痈日久而生脓，脓欲尽而血出，岂有不溃而先出血者？然而现在足不伸为什么呢？盖小肠与大肠不同，小肠细而大肠宽，宽者可以容邪，细者难以容邪，必然之理也。小肠受火煎熬，肠中逼迫，肠不能舒，而左足暂屈，不像生痈者长屈而不伸也。不要以足不伸就信是痈，妄行解毒。然而何以辨别？初病之时，辨其小便中有血无血耳。初痛而足屈，小便无血，乃是生痈；初痛而足屈，小便有血，乃是火痛，不可差错。治法泻其火邪，不必化毒而痛止足伸矣。小柴胡汤加味以治之：柴胡、半夏、甘草各一钱，人参二钱，茯苓五钱，黄芩三钱。水煎服。一剂后足伸，二剂后血痛俱止。（按小柴胡汤非治小肠之方也，何从应效如此之捷？夫小肠火盛者，起于肝胆之郁也，木郁则火生，不敢犯心而犯小肠耳。夫火性炎上，今反下炽，拂火之性矣，所以小肠受而作痛也。小便流血者，乃小肠之血为火所逼，血恐为火灼干，越出小肠之外，直走膀胱，反使水道不行而流血也。小柴胡舒肝之气，则火气上炎，其性既顺，又得茯苓清渗水气，水流而血自归经，此方之所以奇耳。）
The *Yellow Emperor's Inner Canon* states: Dull pain at the Guanyuan (CV-4) acupoint indicates Small Intestine Ju (Small Intestine Carbuncle); if the flesh in this area is slightly elevated, it is Small Intestine Yong (Small Intestine Abscess). (Guanyuan, also known as the Front-Mu point of the Small Intestine, is located 3 cun below the umbilicus.)
The *Qianjin Fang* (Prescriptions Worth a Thousand Gold) states: In cases of Chang Yong (Intestinal Abscess), there is swelling in the lower abdomen; severe tenderness upon deep palpation; and frequent urination resembling Lin Syndrome (Dysuria).
The *Jue Lun* (Treatise on Jue Syndromes) states: When Shaoyang Qi rebels, joint movement becomes impaired. Those with impaired joint movement cannot walk with their waist or look back with their neck. If Chang Yong occurs, it is incurable, and death ensues if the patient is startled.
Wang Kentang states: The *Qianjin Fang* warns that mismanagement will certainly kill. In Chang Yong, the lower abdomen feels heavy and painful upon deep pressure; urination is frequent and resembles dysuria; sweating occurs frequently accompanied by aversion to cold; the skin is rough like fish scales (Jia Cuo); the abdominal wall is tense as if swollen; and a rapid pulse indicates pus formation in the Small Intestine. (From *Yixue Zhunsheng*)
Chen Wuyue states: In Chang Yong, the body skin is rough like fish scales, the abdominal wall is tense but soft upon palpation, resembling a swelling, yet there are no accumulations in the abdomen and no fever. A rapid pulse indicates pus within the intestine, formed by long-standing accumulation of Yin-Cold. Therefore, the *Jingui Yaolue* uses Fuzi (Aconite Lateralis Radix Preparata) to warm. If the pulse is slow and tight, pus has not yet formed; purgatives may be used, and blood should be expelled. If the pulse is surging and rapid, pus has formed; purgatives are contraindicated, as this is caused by internal heat binding. Thus, the *Jingui Yaolue* uses Dahuang (Rhei Radix et Rhizoma) to promote drainage.
Zhang Zhongjing states: Chang Yong presents with stuffiness and hardness in the lower abdomen, characterized by lower abdominal pain and fullness, and frequent urination resembling dysuria. Chang Yong belongs to the same category as Fei Yong (Lung Abscess) and Gan Yong (Liver Abscess).
Chao Yuanfang states: A surging and rapid pulse indicates existing pus; a slow and tight pulse indicates no pus. In severe cases, the abdomen distends significantly, producing a splashing sound when turning over; sores may appear around the umbilicus; pus may discharge from the umbilicus; or pus and blood may pass through the stool.
Zhang Jingyue states: The classic text says that Chang Yong must not be startled; startling causes intestinal rupture and death. Therefore, patients should move slowly when sitting, lying down, or turning over. They should occasionally drink thin rice gruel and take Bazhen Tang (Eight-Treasure Decoction) to consolidate Yuan Qi, resting quietly and regulating their condition to preserve life. (From *Jingyue Quanshu*)
Xue Lizhai states: This syndrome is caused by emotional disturbances and dietary irregularities.
He further states: If pus discharges from the umbilicus, it is an untreatable condition.
Sun Simiao states: In Chang Yong, the lower abdomen is heavy and tender upon pressure; urination resembles dysuria; sweating occurs frequently accompanied by aversion to cold; the skin is rough like fish scales; the abdominal wall is tense; in severe cases with significant swelling, the abdomen distends with a splashing sound upon turning; sores may appear around the umbilicus; pus may discharge from the umbilicus or via the stool. These are caused by emotional disturbances and dietary irregularities. A slow and tight pulse indicates no pus; treat with Dahuang Tang (Rhubarb Decoction) to purge. A surging and rapid pulse indicates existing pus; treat with Yiyi Ren Tang (Coix Seed Decoction) to drain pus. Lower abdominal pain with difficult urination indicates pus obstruction; treat primarily with Mudanpi San (Moutan Powder).
Chen Shigong states: At the onset of Chang Yong, there is fever and aversion to cold; the pulse is hollow and rapid; the skin and hair are rough and crisscrossed; the abdominal wall becomes tense and gradually swollen, extremely painful upon pressure; the stool feels heavy; urination is obstructed and resembles dysuria. In severe cases, the umbilicus protrudes, the abdomen distends, and there is a splashing sound upon turning. All these result from Damp-Heat and Stasis entering the Small Intestine to form an abscess. (From *Waike Zhengzong*)
He further states: In men, sudden and urgent running leads to impaired gastrointestinal transport and unsmooth flow, causing败血 (defective blood) and turbid Qi to stagnate and form the disease. In women, postpartum deficiency with prolonged bed rest without rising can cause it. Women experiencing difficult labor exerting excessive force can develop it. Postpartum failure to expel stasis leads to defective blood accumulating in the intestines and forming knots. Hunger, satiety, and overwork, or carrying heavy loads, damage the intestines and stomach. Intoxication, overeating, or sexual fatigue excessively injure essence and vitality; consuming raw and cold foods together causes Qi and Blood disharmony, generating Dampness and Phlegm, leading to intestinal stuffiness, impaired transformation, and Qi-Blood stagnation, all of which can cause this condition.
He further states: In the early stage before pus formation, if the lower abdomen aches deeply, resembling Ben Tun (Running Piglet) syndrome, with dribbling urination, use Dahuang Tang to purge; once stasis is cleared, peace returns. If the constitution is weak with a fine pulse and purgatives are contraindicated, use Huoxue Sanyu Tang (Invigorate Blood and Resolve Stasis Decoction) to harmonize and promote flow.
He further states: If the abdomen is soft yet painful, the lower abdomen is urgently distended, and pus is frequently discharged, the toxin is unresolved; treat with Mudanpi Tang.
He further states: Once pus has formed, presenting with abdominal pain, distension, anorexia, and painful dribbling urination, treat primarily with Yiyiren Tang.
He further states: If pus discharges from the umbilicus, abdominal distension persists, appetite decreases, the complexion is pale, and spirit is fatigued, this indicates dual deficiency of Qi and Blood. Use Bazhen Tang added with Mudanpi (Moutan Cortex), Rougui (Cinnamon Bark), and Bei Wuwei Zi (Schisandra Fruit) to astringe and tonify.
He further states: If the condition lingers for a long time due to neglect and is mistaken for a distension disorder, treating it wrongly allows toxins to attack the five Zang organs and damage the intestines and stomach. This may lead to ulceration of the external genitalia, black spots, loss of luster, absence of pus, continuous discharge of foul fluid, abdominal pain radiating to the yin, incessant irritability, fever, dry mouth, and offensive odors in bedding and rooms. Such cases are untreatable.
Feng Luzhan states: In Small Intestine Yong causing pain, the skin is rough like fish scales, the abdominal wall is tight, soft upon palpation resembling a swelling, with frequent abdominal pain or sores around the umbilicus. Urgent purgation is required. (From *Waike Jinang*)
He further states: A maiden suffered recurrent abdominal pain, poor appetite, sallow complexion, and emaciation. Pediatric treatment focused on clearing heat and resolving accumulation; gynecological treatment focused on unblocking menses and moving blood; and general prescriptions based on deficiency attempted tonification, all without effect. Later, a knowledgeable physician noted: The pulse is large, but the Chi position is exclusively rapid; the skin is rough like fish scales. This indicates Small Intestine Yong, with pus formed and about to rupture. Immediately administer Kuigen (Hibiscus Root) 1 liang, Jinyinhua (Lonicerae Japonicae Flos) 3 qian, Gancao Jie (Licorice Joint) 1 qian, Zaogelaci (Gleditsiae Spina) and Chenpi (Citri Reticulatae Pericarpium) 2 qian each. After two doses, pus and blood discharged profusely. Subsequently, treat with Taiyi Gao (Taiyi Plaster) combined with Renshen (Ginseng Radix et Rhizoma). Stability was achieved after one month.
He further states: Chang Yong is caused by accumulated heat from rich and greasy foods. Symptoms include rough skin, tense abdominal wall, soft upon palpation resembling swelling, sores around the umbilicus, tenderness upon pressing the lower abdomen, frequent urination resembling dysuria, abdominal distension with aversion to cold, fever, and spontaneous sweating. If the pulse is deep and tight with no pus, urgently resolve toxicity. If the pulse is surging and rapid with pus, urgently drain pus. If there is lower abdominal pain with urinary retention, pus is obstructed. However, in Chang Yong, one must never startle the patient; startling causes intestinal rupture. Movements should be slow. Drink thin gruel and take Bazhen Tang to consolidate Yuan Qi, rest quietly, and regulate to ensure survival.
Li Dongyuan states: In Chang Yong with sores around the umbilicus discharging pus, some discharge from the umbilicus itself. Only those passing pus and blood via the stool will heal spontaneously. (From *Shi Shu*)
Shen Douyuan states: For internal intestinal abscesses, verify the diagnosis clearly; do not treat recklessly, as reckless treatment kills. Symptoms include heavy lower abdomen, tenderness upon pressure, urination resembling dysuria, frequent sweating with aversion to cold, rough skin, tense abdominal wall, sores around the umbilicus, pus from the umbilicus, or pus and blood in stool. If swelling is severe on the left and the Cun position of the left wrist is surging and rapid, it is Small Intestine Yong. If swelling is severe on the right and the Cun position of the right wrist is surging and rapid, it is Large Intestine Yong. (From *Yanke Qixuan*)
Zhu Danxi states: Rough skin like fish scales, tight and small abdominal wall, abdominal pain with dribbling urination, frequent sweating or牵引 (pulling) pain to the large abdomen, soft upon palpation resembling swelling, no abdominal masses, no fever, and non-wiry/non-rapid pulse indicate intestinal Yong caused by long-standing Yin-Cold. Use hot and warm agents to warm and disperse. Thus, the *Jingui Yaolue* uses Fuzi to warm.
He Shi states: In Chang Yong, men present with symptoms on the left and women on the right, with legs bent and unable to extend. Mistaking this for Yin Hernia or Cold Damage causes great harm. (From *Jisheng Fang*)
Hu Gongbi states: Pressing 1.3 cun below the umbilicus reaches the curvature of the intestines; the Large Intestine coils on the left, and the Small Intestine curves on the right. Abscess formation results from long-standing cold toxin, where intestinal pus cannot vent outward, thus forming internally. Externally, there is no visible shape, but deep pressure causes severe pain. Toxin on the left prevents left leg extension; toxin on the right prevents right leg extension. The skin outside the toxin shows slight wrinkles and mild swelling upon close observation. This condition requires Niujiao Jiu (Ox Horn Gelatin Wine) taken with Taiyi Gao Wan (Taiyi Pill) to pursue pus and resolve toxicity. Poor management renders it incurable. (From *Qingnang*)
Dou Hanqing states: Heat in the Bladder with accumulated toxin failing to flow results in this syndrome, causing hard nodules at the umbilicus, painful urination, and relentless diarrhea day and night. Externally, apply ten scallions with roots, mashed, to the umbilicus.
He further states: Female Chang Yong differs from males; it arises from Heart channel toxin flowing into the Small Intestine channel, manifesting at the umbilicus as hard as stone. This is a malignant sign; use internal support methods.
He further states: In Chang Yong, if pus discharges via stool or umbilicus, it is untreatable.
The *Neijing* states: Chang Yong must not be startled; startling causes intestinal rupture and death. Patients must move slowly when sitting, lying, or turning. Occasionally drink thin gruel and take Bazhen Tang to consolidate Yuan Qi, rest quietly, and regulate to preserve life. (From *Jingyue Quanshu*)
*Millejin Fang* Moxibustion method: Bend both elbows, align the sharp bone of the elbow tip, and moxa 100 Zhuans. Pus and blood discharge, and the patient stabilizes.
*Mai Jing* asks: How does one know if a woman of the Yulin guard has an intestinal abscess? The Master answers: The pulse is slippery and rapid. Slippery indicates excess; rapid indicates heat. Slippery relates to Ying (Nutrient) Qi; rapid relates to Wei (Defensive) Qi. Wei Qi descends rapidly, Ying Qi rises slipperily; their conflict creates turbid敗浊 (defective turbidity), causing lower abdominal stuffiness and hardness, difficult or spontaneous urination, spontaneous sweating, or aversion to cold. Pus has formed. If the pulse is slow and tight, it indicates blood stasis; expulsion of blood brings relief.
Chen Yuangong states: Some present with severe abdominal pain, thirst, inability to extend the left leg (pain worsens upon extension), and unbearable tenderness upon pressure. People assume intestinal abscess. However, intestinal abscesses differ between Large and Small Intestines. Bending the right leg indicates Large Intestine Yong; bending the left leg indicates Small Intestine Yong. Current left leg flexion confirms Small Intestine Yong. Large Intestine Yong is easier to treat; Small Intestine Yong is harder because the Large Intestine can be purged, while the Small Intestine is difficult to purge. Yet, with proper method, why not purge? Fire from the Large Intestine exits via feces; fire from the Small Intestine exits via urine. Xiedu Zhishen Tang: Jinyinhua 3 liang, Fuling (Poria) and Yiyiren (Coix Semen) 1 liang each, Gancao (Licorice), Cheqianzi (Plantaginis Semen), Liuji Nu (Lysimachiae Herba), Zexie (Alismatis Rhizoma) 3 qian each, Rougui (Cinnamon Bark) 1 fen. Decoct in water. After one dose, watery discharge flows heavily; after two doses, pain greatly reduces; after three doses, complete recovery. This formula consists mainly of diuretics, with only Jinyinhua resolving toxicity. Why such efficacy? Small Intestine toxin must be resolved internally. Among internal-resolving herbs, none replace Jinyinhua, as others damage healthy Qi, which must not be injured in the Small Intestine. Thus, Jinyinhua is the sovereign herb. Although it does not enter the Small Intestine directly, combined with Fuling, Yiyiren, Cheqianzi, and Zexie, it guides the action to the Small Intestine. A little Rougui guides it to the Bladder for excretion via urine. To prevent overwhelming fire toxin, Liuji Nu accelerates removal, and Gancao moderates. This avoids stagnation and harshness, allowing fire toxin to exit via the Bladder and Small Intestine. (From *Bianzheng Lu*)
He further states: Someone cries out in pain in the left abdomen, unbearable upon pressure. People assume food stagnation in the Large Intestine, but it is actually Small Intestine Yong! All intestinal abscesses involve leg flexion. Here, the leg is not flexed, seemingly contradicting intestinal abscess. However, abscesses inside the intestine cause leg flexion: Large Intestine abscess bends the right leg; Small Intestine abscess bends the left leg. Abscesses outside the intestine do not cause leg flexion. Pain on the left indicates Small Intestine Yong; pain on the right indicates Large Intestine Yong. Food stagnation pain comes and goes; abscess pain is fixed and unceasing. Thus, left-sided pain indicates an abscess outside the Small Intestine. Abscesses inside the intestines can be ruptured/drained; those outside cannot, as there is no exit path, leading to death. Small Intestine cases are especially critical and require early treatment. Neihua Dan: Jinyinhua 4 liang, Cheqianzi 5 qian, Baifuling (Poria) and Yiren (Coix Semen) 1 liang each, Sheng Gancao (Raw Licorice) 3 qian. Decoct in water. Three doses stop pain; four doses cure. (This is a variation of the previous formula. The previous formula promotes diuresis while resolving toxicity. This formula adds Danggui (Angelicae Sinensis Radix) 2 liang to nourish blood while promoting diuresis and resolving toxicity. When the abscess ruptures, diuresis helps expel toxin easily. Before rupture, without nourishing blood, diuresis depletes blood, making digestion difficult. Note this distinction. Early treatment is essential; otherwise, even if healed, stasis flows outside the intestine, causing lifelong abdominal pain. Be cautious.)
He further states: Someone experiences sudden severe abdominal pain, hematuria, and inability to extend the left leg. People assume Small Intestine Yong, but it is actually Small Intestine Fire Excess! Small Intestine Yong always involves bending the left leg. Now the leg is extended, clearly indicating Yong, yet why "Fire Excess"? Abscesses have signs; they do not suddenly bleed immediately. Long-standing abscesses generate pus; bleeding occurs only when pus is nearly exhausted. How could bleeding occur before rupture? Why is the leg not extended? The Small Intestine is narrow, while the Large Intestine is wide. Wide channels accommodate pathogens; narrow ones do not. The Small Intestine suffers from fire roasting, internal pressure prevents relaxation, causing temporary left leg flexion, unlike the sustained flexion in Yong. Do not assume Yong solely based on leg extension and prescribe detoxifiers blindly. How to differentiate? Check for blood in urine at onset. Initial pain with leg flexion and no blood in urine indicates Yong. Initial pain with leg flexion and blood in urine indicates Fire Pain. Treatment: Purge fire; detoxification is unnecessary. Pain stops, and leg extends. Modified Xiaochaihu Tang: Chaihu (Bupleuri Radix), Banxia (Pinelliae Rhizoma), Gancao (Licorice) 1 qian each, Renshen (Ginseng) 2 qian, Fuling (Poria) 5 qian, Huangqin (Scutellariae Radix) 3 qian. Decoct in water. One dose extends the leg; two doses stop bleeding and pain. (Note: Xiaochaihu Tang is not typically for the Small Intestine. Why such swift effect? Small Intestine Fire Excess originates from Liver-Gallbladder depression. Wood depression generates fire; fearing the Heart, it attacks the Small Intestine. Fire naturally rises; here it blazes downward, violating its nature, causing Small Intestine pain. Hematuria occurs because fire forces Small Intestine blood out, fearing desiccation, it bypasses the Small Intestine, enters the Bladder, obstructs water pathways, and causes bleeding. Xiaochaihu soothes Liver Qi, allowing fire to rise normally. With Fuling clearing dampness, water flows, and blood returns to its vessels. This explains the formula's miracle.)